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The global NAFLD epidemic

Abstract

NAFLD is a clinical syndrome characterized by predominant macrovesicular steatosis of the liver. The clinical and histological phenotypes of NAFLD extend from a nonalcoholic fatty liver to NASH. Although the prevalence of NAFLD is increasing globally, and it is set to become the predominant cause of chronic liver disease in many parts of the world, the epidemiology and demographic characteristics of NAFLD vary worldwide. Indeed, the condition is associated with obesity and insulin resistance in most cases in the Western world, but the disease manifests at a lower BMI in Asian countries and many patients do not seem to have insulin resistance as determined using conventional methods. The similarities and differences in the epidemiology of NAFLD in different regions of the world are discussed and the potential role of genetics and insulin resistance in disease progression is also presented.

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Figure 1: The prevalence of NAFLD plotted as a function of the prevalence of obesity in various countries around the world.

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Acknowledgements

Role of Funding Agencies: This work is supported in part by a grant from the NIH DKRO1081410 to A. J. Sanyal, which provided protected time for data collection, analysis and writing of the Perspectives. There is no conflict of interest with funding agencies. The authors have received funding support from the American Gastroenterological Association (AGA) Foundation Sucampo ASP Designated Research Award in Geriatric Gastroenterology and by a T. Franklin Williams Scholarship Award. Funding was also provided by: Atlantic Philanthropies, Inc., the John A. Hartford Foundation, the Association of Specialty Professors and the AGA and K23 DK090303 to R. Loomba. The authors' research work was also funded in part with the support of the UCSD Digestive Diseases Research Development Center, U. S. PHS grant #DK080506.

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The authors contributed equally to researching data for this article, writing the article and discussion of content. A. J. Sanyal reviewed and edited the manuscript before submission.

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Correspondence to Arun J. Sanyal.

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Competing interests

R. Loomba has received research grant funding from the American Gastroenterology Association, Daiichi Sankyo Inc. and Merck Inc. He has also served as a consultant or on the medical advisory board of Corgenix, Gilead, Merck Inc. and Siemens Inc. A. J. Sanyal serves as a consulting advisor for Amylin, Astellas, Bayer-Onyx (where he is on an analysis of data on health-care burden of liver cancer), Exhalenz, Gilead, Ikaria, Pfizer, Salix, Sanofi-Aventis and Takeda. He provided advice on the design of Clinical Research Forms for Gideon trial; however, he is not involved with Virginia Commonwealth University participation in Gideon. He is a member of the data safety monitoring board for Vertex, and has signed a contract to participate on the advisory board for Norgine, which has not materialized and no remuneration has been received. He receives research grants from Gilead, Intercept, Roche, Salix and Sanofi-Aventis, and conducts nonfunded research with CSL Behring, Ferring Lipomics and Regulus. He receives royalty income from UpToDate.

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Loomba, R., Sanyal, A. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol 10, 686–690 (2013). https://doi.org/10.1038/nrgastro.2013.171

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